Healthcare Provider Details

I. General information

NPI: 1952289969
Provider Name (Legal Business Name): DOMINICK OTTOMANELLI, LCSW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 FLETCHER PL
MADISON NJ
07940-2307
US

IV. Provider business mailing address

10 FLETCHER PL
MADISON NJ
07940-2307
US

V. Phone/Fax

Practice location:
  • Phone: 856-208-7719
  • Fax:
Mailing address:
  • Phone: 856-208-7719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. DOMINICK OTTOMANELLI JR.
Title or Position: OWNER/CLINICIAN
Credential: LCSW
Phone: 856-208-7719